2023-05-12T09:11:39-05:00 2022-06-30 450250958 EIDE BAILLY LLP 200 E 10TH ST STE 500 SIOUX FALLS SD 571046375 990 2021-07-01 460226283 WAGNER COMMUNITY MEMORIAL HOSPITAL WAGN 6053843611 513 THIRD STREET SW WAGNER SD 573800280 BRYAN SLABA CEO 6053843611 2023-05-11 1 BRYAN SLABA 999009999 LAURIE HANSON CPA P00851848 6053391999 2023-05-03 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z BRYAN SLABA 513 THIRD STREET SW WAGNER SD 573800280 14104089 0 X WWW.AVERA.ORG/WAGNERHOSPITAL/ X 1947 SD TO PROVIDE HEALTHCARE SERVICES. 7 6 90 7 0 0 4628802 688264 12447674 12796940 345449 95975 16452 16506 17438377 13597685 4750 11949 0 0 8234279 8115489 0 0 0 4849625 4451180 13088654 12578618 4349723 1019067 17265038 17291123 4209880 4209928 13055158 13081195 X WAGNER COMMUNITY MEMORIAL HOSPITAL'S MISSION IS TO PROVIDE CARE AND TREATMENT OF THE SICK; PROVIDE CARE AND SUPPORT OF THE AGED, DISABLED, AND INDIGENT; AND TO PROVIDE FOR THOSE IN NEED OF HOSPITALIZATION REGARDLESS OF RACE, COLOR, CREED, OR ABILITY TO PAY. 0 0 10785278 11949 12796940 WCMH IS A 20 BED CRITICAL ACCESS HOSPITAL EQUIPPED WITH EXTENSIVE ADVANCED SERVICES, INCLUDING AREAS FOR MEDICAL/SURGICAL, PEDIATRIC, INTENSIVE/CORONARY CARE, AND SWING BED/LONG TERM CARE. THE CLINIC IS ADJACENT TO THE HOSPITAL MAKING IT CONVENIENT TO SEE HOSPITAL PATIENTS, AND SHARE LABORATORY SERVICES AND OTHER DIAGNOSTIC EQUIPMENT. OUTREACH SERVICES INCLUDE OB/GYN, PEDIATRICS, ORTHOPEDIC SURGERY, GENERAL SURGERY, UROLOGY, PODIATRY, ENT & AUDIOLOGY. THE PEOPLE OF THE COMMUNITY TRULY BELIEVE IN HAVING ACCESS TO CARE AND SUPPORT THEIR LOCAL MEDICAL PROVIDERS. THE FACILITY SERVES AS THE INPATIENT UNIT FOR THE LOCAL INDIAN HEALTH SERVICES CLINIC AND WORKS COLLABORATIVELY WITH THE IHS PHYSICIANS AND LEADERS TO CARE FOR THE NATIVE AMERICAN POPULATION. WCMH EXPERIENCED 549 INPATIENT DAYS, 606 SWING BED DAYS, 2,145 EMERGENCY DEPARTMENT VISITS, AND 3,189 CLINIC VISITS. 10785278 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 30 0 1 90 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 6 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 0 X X LISA WEISSER 6053843611 513 3RD STREET SW WAGNER SD 573800280 X DAVID KOTAB PRESIDENT 0.50 X X 0 0 0 CHAD PETERS VICE PRESIDENT 0.50 X X 0 0 0 KAREN SOULEK SECRETARY/TREASURY 0.50 X 0 0 0 MITCHEL BREEN DIRECTOR 0.50 X 0 0 0 RACHEL WOODS DIRECTOR 0.50 X 0 0 0 MICHELE JUFFER DIRECTOR 0.50 X 0 0 0 KATHE HENKE DIRECTOR 0.50 X 0 0 0 BRYAN SLABA CEO/ADMINISTRATOR 40.00 X 287348 0 22531 BRITTNEY BARRON VP OF PATIENT SERVICES 40.00 X 157002 0 13960 MIKEALA KOENIG PHYSICIAN 40.00 X 357022 0 30956 JESSICA VANDERHAM NURSE PRACTITIONER 40.00 X 194170 0 9527 JORDAN WEBER PHYSICIANS ASSISTANT 40.00 X 223870 0 6107 LINDSEY NEDVED NURSE PRACTITIONER 40.00 X 163346 0 8034 RYAN KOCER NURSE PRACTITIONER 40.00 X 168859 0 6299 1551617 0 97414 11 0 1 1 AVERA HEALTH 3900 W AVERA DR STE 301 SIOUX FALLS SD 57108 MAINTENANCE CONTRACTS 963580 SCOTT DOOM CONTRACTING INC 39370 MOON MEADOW DR WAGNER SD 57580 CONSTRUCTION/LABOR 876197 AVERA SACRED HEART HOSPITAL 501 S SUMMIT STREET YANKTON SD 57078 MANAGEMENT, IT, SALARIES 547453 JEFFERY D PINTER MD 27952 323RD AVE WINNER SD 57580 PHYSICIAN ED COVERAGE 394111 AVERA MCKENNAN HOSPITAL 1325 S CLIFF AVE SIOUX FALLS SD 57117 MOBILE RADIOLOGY SERVICES 209296 8 659857 28407 688264 PATIENT SERVICE FEES 621110 12564186 12564186 PHARMACY REVENUE 900099 157712 157712 75042 75042 12796940 2379 2379 16506 0 16506 16506 16506 600000 506404 93596 93596 93596 13597685 12796940 0 112481 11949 11949 484553 187633 296920 99313 99313 6110144 5610558 499586 236891 220357 16534 774687 682705 91982 409901 362852 47049 55320 55320 984280 637567 346713 46485 46485 389704 309180 80524 16616 16616 168331 168331 40178 38436 1742 19704 19111 593 142896 142896 743052 649315 93737 64325 64325 MEDICAL SUPPLIES 1294245 1294245 REPAIRS AND MAINTENANCE 358920 295413 63507 DUES AND SUBSCRIPTIONS 86 36 50 127038 38765 88273 12578618 10785278 1793340 0 585480 934225 2447203 2355045 145128 161331 92864 101073 14541443 8787342 5963943 5754101 6963097 7463097 373674 438362 693649 83889 17265038 17291123 904774 1003434 3305106 3206494 4209880 4209928 X 13055158 13081195 13055158 13081195 17265038 17291123 1019067 -993030 0 X 0 1 X 1 1 1 X 4247 4247 9923289 5784742 4138547 4150562 2723490 1427072 463345 279110 184235 5754101 ASSETS LIMITED AS TO USE - AVERA POOLED INVESTMENTS 7463097 F 7463097 X 12604655 -993030 -993030 13597685 0 13597685 12578618 0 12578618 0 12578618 PART X, LINE 2: THE HOSPITAL BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE HOSPITAL WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. 1 1 X 1 X 1 X 1 1 1 0 0 548900 548900 0.04360 1724315 1674791 49524 0.00390 2273215 1674791 598424 0.04750 7 74 4662 4662 0.00040 2 1 2000 2000 0.00020 2 2 3061154 1468393 1592761 0.12660 2 21 5260 5260 0.00040 13 98 3073076 1468393 1604683 0.12760 13 98 5346291 3143184 2203107 0.17510 1 2 9582 9582 0.00080 2 2 749 749 0.00010 2 435 4760 2500 2260 0.00020 5 439 15091 2500 12591 0.00110 1 257012 58085 4689786 4640660 49126 X 1 1 1 1 WAGNER COMMUNITY MEMORIAL HOSPITAL 513 3RD ST SW WAGNER SD 57380 WWW.AVERA.ORG/WAGNERHOSPITAL/ 10571 X X X X WAGNER COMMUNITY MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X SEE LINE 7D NARRATIVE X SEE LINE 7D NARRATIVE X X 1 21 1 SEE LINE 7D NARRATIVE 0 1 X 100.000000000000 200.000000000000 X X X 1 1 X X X X 1 X SEE 16J NARRATIVE X SEE 16J NARRATIVE X SEE 16J NARRATIVE X X X X X X X 1 X 0 X X X X 1 X 0 0 WAGNER COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE WAGNER COMMUNITY MEMORIAL HOSPITAL REPRESENTATIVES REACHED OUT TO LOCAL COMMUNITY MEMBERS AND LEADERS TO DEVELOP A COMMUNITY FOCUS GROUP. THE AMERICAN INDIAN POPULATION WAS IDENTIFIED AS AN UNDERSERVED POPULATION SPECIFIC TO THE HOSPITAL SERVICE AREA. THE FOCUS GROUP CONSISTED OF REPRESENTATIVES FROM THE FOLLOWING: WAGNER COMMUNITY MEMORIAL HOSPITAL BOARD MEMBERS, WAGNER INDIAN HEALTH SERVICE, YANKTON SIOUX TRIBAL POLICE, EMERGENCY MEDICAL TECHNICIAN, COMMUNITY HEALTH NURSE AND SDSU EXTENSION. THE HOSPITAL REPRESENTATIVES INCLUDED THE CEO/ADMINISTRATOR, DIRECTOR OF NURSING, AND CLINICAL COORDINATOR. THE CHNA COMMUNITY FOCUS GROUP MET FOR FOUR MEETINGS THROUGHOUT DECEMBER 2021 TO DISCUSS THE PURPOSE OF THE CHNA, THE GOALS OF THE FOCUS GROUP, AND THE IMPACT ON THE COMMUNITY. WAGNER COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 7D: THE CHNA REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE AT HTTPS://WWW.AVERA.ORG/LOCATIONS/WAGNER-COMMUNITY-MEMORIAL-HOSPITAL-AVERA/ WAGNER COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: PURSUANT TO THE FY22 IMPLEMENTATION STRATEGY ADOPTED BY WAGNER COMMUNITY MEMORIAL HOSPITAL (WCMH), MENTAL HEALTH SERVICES, SUBSTANCE ABUSE, DIABETES, OBESITY AND HEART DISEASE WERE IDENTIFIED AS COMMUNITY NEEDS. THE FACILITY WILL ADDRESS THE IDENTIFIED NEEDS IN FUTURE YEARS, AS FOLLOWS.1. MENTAL HEALTH:A. HOSPITAL EMPLOYEES WILL BE KNOWLEDGEABLE OF BEHAVIORAL HEALTH RESOURCES.B. INCREASING UTILIZATION OF TELEMEDICINE SERVICES(EEMERGENCY AND ETRIAGE)C. THE HOSPITAL WILL CONTINUE TO EMPLOY OR CONTRACT A FULL TIME OR PART TIME PSYCHIATRIC (MEDICATION MANAGEMENT) AND/OR A PSYCHOLOGIC (COUNSELING) PROVIDER.2. SUBSTANCE ABUSE:A. WCMH EMPLOYEES WILL BE KNOWLEDGEABLE OF SUBSTANCE ABUSE RESOURCES AVAILABLE.B. WE WILL INCREASE UTILIZATION OF TELEMEDICINE SERVICES (EADDICTION, ETRIAGE ETC)3. DIABETES:A. PROVIDE DIABETIC EDUCATION OPPORTUNITIES WITHIN THE COMMUNITYB. INCREASE REFERRALS TO DIABETIC EDUCATION PROGRAMS AND RECOURSESC. EDUCATE DIABETIC PATIENTS OF THE AVAILABLE GLUCOSE MONITORS IN TOWN- JAMES DRUG FOR PURCHASE OR AT INDIAN HEALTH SERVICES TO THOSE WHO QUALIFY FOR BENEFITS.4. OBESITY:A. WCMH WILL INCREASE AWARENESS OF LOCAL EXERCISE OPPORTUNITIES WITHIN THE SURROUNDING AREA.B. WCMH WILL CONTINUE TO COLLABORATE WITH THE WAGNER HEALTH AND WELLNESS CONSORTIUM TO PROMOTE AREA EXERCISE PROGRAMSC. WCMH PROVIDERS WILL CONTINUE TO EDUCATE THEIR PATIENTS ON A HEALTHY DIET.5. HEART DISEASE:A. WCMH PROVIDERS WILL CONTINUE TO EDUCATE THEIR PATIENTS ON A HEALTHY DIET AND EXERCISE.B. WCMH WILL USE THE EXISTING PROGRAMS THAT ADDRESS OBESITY WHICH CAN BE CONNECTED MORE BROADLY TO HEART DISEASE.C. INCREASE PATIENT'S COMPLIANCE WITH MEDICATION MANAGEMENT.IN THE CURRENT YEAR THE FACILITY HAS TAKEN THE FOLLOWING ACTIONS TO ADDRESS NEEDS IDENTIFIED IN THE FY19 CHNA:1. EMPLOYED COUNSELOR AND CONTINUE TO EMPLOY PART-TIME PSYCHIATRIC PROVIDER2. STAFF IS AWARE OF SUBSTANCE ABUSE RESOURCES AVAILABLE, DECREASED TIME BETWEEN REFERRAL AND OUTPATIENT EVALUATION. 4. HAVE UTILIZED SOCIAL MEDIA TO INCREASE AWARENESS OF LOCAL EXERCISE OPPORTUNITIES WITH WAGNER HEALTH AND WELLNESS CONSORTIUM.ALL NEEDS IDENTIFIED IN THE FY22 COMMUNITY HEALTH NEEDS ASSESSMENT WILL BE ADDRESSED. WAGNER COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 13H: THE HOSPITAL USES PRESUMPTIVE ELIGIBILITY TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY IF NEEDED. WAGNER COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 16J: PART V, LINE 16A, FAP WEBSITE:HTTPS://WWW.AVERA.ORG/LOCATIONS/WAGNER-COMMUNITY-MEMORIAL-HOSPITAL-AVERA/PART V, LINE 16B, FAP APPLICATION WEBSITE:HTTPS://WWW.AVERA.ORG/LOCATIONS/WAGNER-COMMUNITY-MEMORIAL-HOSPITAL-AVERA/PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:HTTPS://WWW.AVERA.ORG/LOCATIONS/WAGNER-COMMUNITY-MEMORIAL-HOSPITAL-AVERA/PART V, LINE 16J: THE REFERENCE TO THE POLICY AND ITS LOCATION IS SENT WITH ALL STATEMENTS. WAGNER COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 24: THE HOSPITAL FINANCIAL ASSISTANCE POLICY DOES NOT COVER ELECTIVE PROCEDURES. THE HOSPITAL MAY HAVE CHARGED FAP ELIGIBLE PATIENTS GROSS CHARGES FOR SERVICES THAT ARE NOT COVERED UNDER THE FINANCIAL ASSISTANCE POLICY. 1 1 - WAGNER COMMUNITY CLINIC AVERA 513 3RD ST SW WAGNER SD 57380 CLINIC PART I, LINE 3C: IN ADDITION TO UTILIZING FPG TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE, THE HOSPITAL REVIEWS INSURANCE STATUS AND USES PRESUMPTIVE ELIGIBILITY. PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. LINES 7E, 7F AND 7I WERE OBTAINED UTILIZING THE ACTUAL GENERAL LEDGER SYSTEM. LINE 7G WAS OBTAINED FROM THE MEDICARE COST REPORT. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDED PROVIDER-BASED CLINIC REVENUE OF $941,442 LESS EXPENSE OF $1,584,059, FOR A NET BENEFIT OF $642,617. PART II, COMMUNITY BUILDING ACTIVITIES: THE CEO IS INVOLVED IN THE ROTARY CLUB, WHICH IS MADE UP OF BUSINESS LEADERS WHO WORK WITH COMMUNITY SERVICE ORGANIZATION TO ENHANCE THE COMMUNITY. THE CEO IS ALSO ACTIVE IN THE CHAMBER OF COMMERCE.WCMH HOSTED AN 8TH GRADE CAREER FAIR FOR THE REGIONAL SCHOOLS. EIGHTH GRADERS MUST SELECT CAREER PATHWAYS FOR HIGH SCHOOL REGISTRATION; THUS, THE GOAL OF THE CAREER FAIR IS TO EXPOSE STUDENTS TO THE TECHNICAL SKILLS AND EDUCATION NEEDED TO BE SUCCESSFUL IN BUSINESS AND INDUSTRY. THE HOSPITAL ASSISTS IN ORGANIZING POINT OF DISTRIBUTION (POD) EVENTS, AS WELL AS ADMINISTERING THE INFLUENZA VACCINE TO STUDENTS AND POD VOLUNTEERS AT THE WAGNER COMMUNITY SCHOOL IN CONJUNCTION WITH THE CHARLES MIX POD MANAGER AND CHARLES MIX COMMUNITY HEALTH NURSE.STRENGTHENING OUR COMMUNITY (SOC) IS THE PROJECT AWARE ADVISORYCOMMITTEE THAT IS MADE UP OF A CROSS SECTION OF COMMUNITY MEMBERS WHOSE GOAL IS TO BUILD RELATIONSHIPS AND CREATE CAPACITY TO BECOME A SELF-HEALING COMMUNITY. THE FOCUS IS ON MENTAL HEALTH WELL-BEING. SOC INCLUDES A JOINT EFFORT WITH SEVERAL COMMUNITY ORGANIZATIONS CONCERNED WITH THE MENTAL WELL-BEING OF OUR COMMUNITY'S YOUTH.THE WAGNER COMMUNITY MEMORIAL HOSPITAL HAS PARTNERED WITH SEVERAL COMMUNITY ENTITIES TO FORM THE WAGNER AREA HEALTH & WELLNESS CONSORTIUM. THIS GROUP COMBINES RESOURCES TO EMPHASIZE HEALTH EDUCATION AND ACTIVITIES TO PROMOTE IMPROVED HEALTH AND WELLNESS. PART III, LINE 2: THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON THE PERCENTAGE OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL IN 2021. THEREFORE, 22.6% CAN REASONABLY BE CONSIDERED A COMMUNITY BENEFIT AS IT WOULD HAVE BEEN WRITTEN OFF TO CHARITY CARE. PART III, LINE 4: THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES IMPLICIT PRICE CONCESSIONS IS ON PAGES 10 AND 11 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR THE FISCAL YEAR ENDING 6/30/2022.MANY PATIENTS IN OUR SERVICE AREA QUALIFY FOR MEDICARE. THE FACILITY PROVIDES SERVICES TO THESE PATIENTS REGARDLESS OF IF THERE IS A SHORTFALL OR SURPLUS. PROVIDING SERVICES TO THIS POPULATION PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH ARE NEEDED IN OUR COMMUNITY, THEREBY PROVIDING A BENEFIT TO OUR COMMUNITY.TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY THE CENTERS FOR MEDICAID AND MEDICARE SERVICES. PART III, LINE 9B: THE COLLECTION PRACTICES AS SET FORTH IN THE POLICY REQUIRES THAT IF A PATIENT QUALIFIES FOR CHARITY CARE, NO BILL WILL BE SENT. INSTEAD, A LETTER INDICATING THAT THE PATIENT'S BILL HAS BEEN COMPLETELY FORGIVEN WILL BE SENT. WHEN SENDING A BILL TO ANY PATIENT, THE ORGANIZATION SHALL INCLUDE ON THE BILL A STATEMENT THAT INDICATES IF THE PATIENT MEETS CERTAIN INCOME REQUIREMENTS THE PATIENT MAY BE ELIGIBLE FOR A GOVERNMENT-SPONSORED PROGRAM OR FOR FINANCIAL ASSISTANCE FROM THE ORGANIZATION FOR HELP IN PAYING FOR THE SERVICES THAT WERE PROVIDED. IN ADDITION, A STATEMENT PROVIDES THE PATIENT WITH AN ORGANIZATION CONTACT RESOURCE WHOM THE PATIENT MAY OBTAIN INFORMATION ABOUT THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY FOR LOW-INCOME UNINSURED PATIENTS AND HOW TO APPLY FOR SUCH ASSISTANCE FOR THE PAYMENT OF SERVICES THAT WERE PROVIDED.IF THE PATIENT QUALIFIES FOR THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY FOR LOW-INCOME, UNINSURED PATIENTS AND IS COOPERATING WITH THE ORGANIZATION WITH REGARD TO EFFORTS TO SETTLE AN OUTSTANDING BILL WITHIN A REASONABLE TIME PERIOD, THE ORGANIZATION OR ITS AGENT SHALL NOT SEND, NOR INTIMATE THAT IT WILL SEND, THE UNPAID BILL TO ANY OUTSIDE COLLECTION AGENCY. AT SUCH TIME AS THE ORGANIZATION SENDS THE UNCOLLECTED ACCOUNT TO AN OUTSIDE COLLECTION AGENCY, THE AMOUNT REFERRED TO THE AGENCY SHALL REFLECT THE REDUCED-PAYMENT LEVEL FOR WHICH THE PAITENT WAS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY FOR LOW-INCOME UNINSURED PATIENTS. WCMH DOES NOT REPORT ANY DATA TO ANY OF THE CREDIT AGENCIES, HOWEVER, THE COLLECTION AGENCIES WCMH UTILIZES MAY REPORT TO THE CREDIT AGENCIES. PART VI, LINE 2: IN ADDITION TO PREPARING A COMMUNITY HEALTH NEEDS ASSESSMENT DURING THE FISCAL YEAR ENDED JUNE 30, 2022, WCMH DETERMINES PATIENT NEEDS THROUGH CONSTANT COMMUNICATION WITH PATIENTS, PRIMARY AND SPECIALTY PROVIDERS, AND STATE AND FEDERAL GOVERNMENTAL HEALTH AGENCIES. WCMH STRIVES TO CONSISTENTLY INVESTIGATE, ANALYZE, AND DETERMINE THE GREATEST NEEDS OF OUR COMMUNITY. PART VI, LINE 3: AT EACH POINT OF ADMISSION, NOTICES ARE POSTED STATING WCMH OFFERS FINANCIAL ASSISTANCE WITH CONTACT INFORMATION FOR ASSISTANCE. REFERENCE TO THE POLICY IS GIVEN TO THE PATIENT UPON ADMISSION AND AGAIN WITH THE NOTICE/STATEMENT FOR PAYMENT, INCLUDING CONTACT INFORMATION FOR ASSISTANCE. IF THE PATIENT EXPRESSES INTEREST IN FINANCIAL ASSISTANCE, A PATIENT ADVOCATE WILL ASSIST IN COMPLETING THE PROPER APPLICATION. PART VI, LINE 4: WAGNER IS A RURAL COMMUNITY LOCATED IN SOUTHERN CHARLES MIX COUNTY IN SOUTH DAKOTA WHICH HAS MANY HEALTH DISPARITIES WITH UNMET NEEDS. IF ONE LOOKS AT SOUTHERN CHARLES MIX COUNTY, THE AVERAGE INDIVIDUAL INCOME IS $24,587 WITH THE MEDIAN FAMILY INCOME AT $52,981. THIS IS COMPARED TO THE NATIONAL AVERAGE OF $37,638 AND $69,021. SOUTHERN CHARLES MIX COUNTY HAS A FEDERAL POVERTY LEVEL OF 22.6% COMPARED TO 12.3% FOR SOUTH DAKOTA. COUNTY EDUCATION DEMOGRAPHICS INCLUDE 88.2% OF RESIDENTS HAVING A HIGH SCHOOL DIPLOMA OR HIGHER AND 22.4% HOLDING A BACHELOR'S DEGREE OR HIGHER, COMPARED TO A NATIONAL LEVEL OF 88.9% HAVING A HIGH SCHOOL DIPLOMA OR HIGHER AND 33.7% HAVING A BACHELOR'S DEGREE OR HIGHER. ACCORDING TO THE US CENSUS BUREAU MOST RECENT DATA 33.6% OF SOUTHERN CHARLES MIX COUNTY ARE OF AMERICAN INDIAN DESCENT COMPARED TO 9.0% FOR SOUTH DAKOTA AND 1.3% NATIONALLY. THE WAGNER SERVICE AREA IS ALSO CONSIDERED A HEALTH PROFESSIONAL SHORTAGE AREA-LOW INCOME GEOGRAPHIC. THIS IS DUE TO ITS ACCESS TO FEW PROVIDERS AND LONG DISTANCES BETWEEN OTHER RURAL COMMUNITIES. OUR SERVICE AREA INCLUDES A COMMUNITY CLINIC IN ADDITION TO THE WAGNER INDIAN HEALTH SERVICES CLINIC AND THE VA CLINIC. MANY CLINICS PROVIDE ONLY PRIMARY CARE SERVICES AND ARE OFTEN STAFFED BY NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS. IN CASES WHERE MORE SPECIALIZED CARE IS NEEDED, PATIENTS HAVE THE OPTION TO TRAVEL TO YANKTON, SOUTH DAKOTA, WHICH IS AN 110 MILE ROUND TRIP OR TRAVEL 222 MILES ROUND TRIP TO SIOUX FALLS, SOUTH DAKOTA, WHICH IS ALSO THE AREA'S TERTIARY CARE HUB FOR ALL TYPES OF SPECIALTY CARE. WE ALSO FIND CHARLES MIX COUNTY, SD IN AN AREA IN WHICH THERE IS A HIGH PERCENTAGE OF UNINSURED UNDER THE AGE OF 65. ACCORDING TO THE US CENSUS BUREAU, OUR COUNTY INCLUDES 18.5% UNINSURED AS COMPARED TO 9.8% NATIONALLY.*ALL STATISTICS FOR THIS REPORT WERE OBTAINED FROM CENSUS.GOV PART VI, LINE 5: WCMH PROVIDES COMMUNITY HEALTH IMPROVEMENT SERVICES WHICH INCLUDE: COMMUNITY CPR CLASSES; BLOOD PRESSURE SCREENINGS AT AREA EVENTS; SCHOLARSHIPS TO LOCAL HIGH SCHOOL GRADUATES; DAKOTA SENIOR MEAL DELIVERY FOR LOCAL ELDERLY IN OUR COMMUNITY; OPERATING AN EMERGENCY ROOM AVAILABLE TO ALL REGARDLESS OF ABILITY TO PAY EQUIPPED WITH THE LATEST TECHNOLOGY INCLUDING TELEMEDICINE. PART VI, LINE 6: WCMH IS A MANAGED FACILITY OF AVERA HEALTH. AVERA HEALTH AND THE HOSPITAL WORK COOPERATIVELY TO ENHANCE HEALTHCARE THROUGHOUT THE COMMUNITY SERVED BY THE HOSPITAL. WCMH ALSO HAS ACCESS TO "BACK OFFICE" SUPPORT SERVICES, SUCH AS LEGAL CONSULTATION, QUALITY BENCHMARKING, CODING, COMPUTER SERVICES, CONTRACT NEGOTIATIONS, ADMINISTRATIVE CONSULTATION, GROUP PURCHASING, HUMAN RESOURCE ASSISTANCE AND MANY OTHER SERVICES. AVERA HEALTH IS ABLE TO PROVIDE THESE SERVICES TO WCMH AT A COST BELOW THAT WHICH THE HOSPITAL COULD OTHERWISE ACHIEVE. IN TURN, LOCAL CAREGIVERS ARE ABLE TO DEVOTE MORE RESOURCES TO PATIENT AND RESIDENT CARE. AVERA HEALTH AND WCMH DEDICATE RESOURCES TO ENDEAVORS THAT MAKE A POSITIVE DIFFERENCE TO IMPROVE THE HEALTH OF THE COMMUNITIES THEY SERVE. THESE ACTIVITIES INCLUDE LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS, ECONOMIC DEVELOPMENT, PHYSICAL IMPROVEMENTS IN THE COMMUNITY, CONTRIBUTIONS TO NONPROFIT COMMUNITY ORGANIZATIONS, NONPROFIT EVENT SPONSORSHIPS, DONATED MEDICAL SUPPLIES, COMMUNITY HEALTH EDUCATION AND SUPPORT GROUPS, HEALTH SCREENINGS, FLU-SHOT CLINICS, COMMUNITY HEALTH EDUCATION AND VARIOUS OTHER ACTIVITIES. X X 0 0 0 0 0 0 0 0 0 MIKEALA KOENIG PHYSICIAN 357022 0 0 0 0 0 0 0 30956 0 387978 0 0 0 BRYAN SLABA CEO/ADMINISTRATOR 287348 0 0 0 0 0 14320 0 8210 0 309878 0 0 0 JORDAN WEBER PHYSICIANS ASSISTANT 223870 0 0 0 0 0 0 0 6107 0 229977 0 0 0 JESSICA VANDERHAM NURSE PRACTITIONER 194170 0 0 0 0 0 0 0 9527 0 203697 0 0 0 RYAN KOCER NURSE PRACTITIONER 168859 0 0 0 0 0 0 0 6299 0 175158 0 0 0 LINDSEY NEDVED NURSE PRACTITIONER 163346 0 0 0 0 0 0 0 8034 0 171380 0 0 0 BRITTNEY BARRON VP OF PATIENT SERVICES 157002 0 0 0 0 0 8134 0 5826 0 170962 0 0 0 JESSICA PETERS FAMILY RELATIONSHIP WITH CHAD PETERS, BOARD MEMBER 99313 EMPLOYEE COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 2 DIRECTOR MITCHEL BREEN AND DAVID KOTAB HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THERE IS ONLY ONE CLASS OF MEMBER. ANY INDIVIDUAL, PARTNERSHIP, CORPORATION OR ASSOCIATION HAVING LEGAL ENTITY, WHO HAS CONTRIBUTED $25 OR MORE TO THE CORPORATION WITH REQUEST OF MEMBERSHIP AT THE TIME OF DONATION, SHALL BE A MEMBER THEREOF AND EACH MEMBER SHALL HAVE ONE VOTE AT ALL MEETINGS OF THE MEMBERS OF THE CORPORATION. MEMBERSHIP OF ANY INDIVIDUAL WHO SHALL BECOME DECEASED SHALL REVERT BY REQUEST TO THAT INDIVIDUAL'S NEXT OF KIN OR ACCORDING TO HIS WILL. ANY MEMBER WHO HAS CONTRIBUTED $50 OR MORE SHALL HAVE THE RIGHT TO TRANSFER SUCH MEMBERSHIP TO HIS OR HER SPOUSE. SAID TRANSFER TO BE APPROVED BY THE BOARD OF DIRECTORS. THE BASIS FOR MEMBERSHIP IS ON NON-REFUNDABLE CONTRIBUTIONS. FORM 990, PART VI, SECTION A, LINE 7A ONLY ONE CLASS OF MEMBER EXISTS. AT THE ANNUAL MEETING, MEMBERS APPROVE THE MINUTES OF THE LAST ANNUAL MEETING, ELECT BOARD MEMBERS OF THE WAGNER COMMUNITY MEMORIAL HOSPITAL, AND VOTE ON OTHER BUSINESS THAT MAY BE PROPERLY BROUGHT BEFORE THE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS REQUIRE MEMBER APPROVAL. FORM 990, PART VI, SECTION A, LINE 8B WAGNER COMMUNITY MEMORIAL HOSPITAL DOES NOT HAVE COMMITTEES. FORM 990, PART VI, SECTION B, LINE 11B THE CEO WILL REVIEW THE 990. AFTER THE FORM 990 HAS BEEN REVIEWED, IT WILL BE FORWARDED TO THE MEMBERS OF THE GOVERNING BODY FOR THEIR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C DIRECTORS AND MANAGEMENT OFFICIALS ARE REQUIRED TO COMPLETE ANNUAL CONFLICT OF INTEREST QUESTIONNAIRES WHICH ARE MONITORED AND TRACKED. THE QUESTIONNAIRES ARE REVIEWED BY THE BOARD FOR ANY POSSIBLE CONFLICTS WITH ANY NOTED CONFLICTS BEING BROUGHT TO MANAGEMENT'S ATTENTION. INQUIRIES OF CONFLICTS ARE ALSO REVIEWED AT THE MONTHLY BOARD MEETINGS. AFTER A CONFLICT IS DEEMED TO EXIST, THE BOARD DETERMINES THE LEVEL OF PARTICIPATION OF THE POTENTIAL CONFLICTING MEMBER. FORM 990, PART VI, SECTION B, LINE 15A AVERA SACRED HEART HEALTH SERVICES AND WAGNER COMMUNITY MEMORIAL HOSPITAL COMPENSATION COMMITTEE USE COMPARABILITY DATA TO DETERMINE APPROPRIATE COMPENSATION OF THE CEO BASED ON EXPERIENCE AND PERFORMANCE. THE COMPENSATION AMOUNT IS APPROVED ANNUALLY BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART VII IN ADDITION TO HIS ROLE AS CEO/ADMINISTRATOR, BRYAN SLABA HAS OVERSIGHT OF FINANCIAL OPERATIONS OF THE ENTITY.